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234 D. Barolet Figure 11 Pictures of a 47-year-old caucasian patient before CO2 laser resurfacing, and 1 week and 3 weeks post procedure after 4 LED treatments given 48 hours apart. ogy. MMP inhibition through LED treatments may reduce lupus-induced damage in inflamed tissues. Photorejuvenation In aged photo-damaged human skin, collagen synthesis is reduced with a concomitant elevation of matrix MMP expres- sion.30 Hence, a possible strategy for treating and preventing the clinical manifestations of skin aging is the restoration of the collagen deficiency by the induction of new collagen syn- thesis and reduction of MMP. Using a variety of LED light sources in the visible to NIR regions of the spectrum, in vitro studies have revealed that LED can trigger skin collagen synthesis with concurrent re- duction in MMP. A significant increase in collagen produc- tion after LED treatment has been shown in various experi- ments, including fibroblasts cultures, third-degree burn animal models, and human blister fluids, and skin biop- sies.14,31-34 In clinical studies, the increase in collagen pro- duction with concurrent MMP-1 reduction has been seen in association with improved appearance of photodamaged skin. Table 2 shows currently available LED sources for skin rejuvenation. Photoprophylaxis or Photoprevention Photoprophylaxis is a novel approach that we were the first to introduce—to the best of our knowledge—in the use of LEDs for the prevention of cutaneous manifestations after a trauma. If LED therapy is administered several times prior to a UV insult, a mechanical trauma such as a CO2 laser treatment or a surgery, one may prevent undesirable consequences such as sunburn, postinflammatory hyperpigmentation (PIH), or Figure12 Pictureofafemalepatientbeforeandaftercomplementary LED treatments for diffuse-type rosacea. hypertrophic scarring, respectively. These LED-preventative modalities will be discussed hereafter. Sunburn Prevention Beyond the repair of previous UV insults to the skin, visible to NIR light might offer protection against upcoming photo- damage. It has been suggested that protective mechanisms against skin UV-induced damage may be activated by IR ex- posure in a number of in vitro studies using primary-culture human fibroblasts.35,36 Therefore, LED treatment could stim- ulate skin resistance to UV damage. Results from our own laboratory testing suggest that LED 660 nm treatment before UV exposure provides significant protection against UV-B induced erythema.37 The induction of cellular resistance to UV insults may possibly be explained by the induction of a state a natural resistance to the skin (possibly via the p53 cell signaling pathways) without the drawbacks and limitations of traditional sunscreens.38 These results represent an encouraging step toward expanding the potential applications of LED therapy and could be useful in the treatment of patients with anomalous reactions to sun- light such as polymorphous light eruption or lupus. Postinflammatory Hyperpigmentation Prevention PIH is a frequently encountered problem and represents the sequelae of various cutaneous disorders as well as therapeutic interventions especially on Asian and dark complexion pa- tients. A preventative and complementary approach to ther- mal laser induced PIH using LED therapy is possible. Accord- ing to unpublished work performed in our laboratory, the use of LED 660 nm therapy can prevent or treat PIH. On the basis of photographic analysis and melanin content measure- ments, most patients can achieve substantial reduction or absence of PIH lesions in the LED-treated areas (versus con- Table 2 LED Sources Used for Noninvasive Skin Rejuvenation Wavelength (nm) 590 630 660 System Name GentleWaves Omnilux Revive LumiPhase-R Manufacturer Light Bioscience Phototherapeutics OpusMedPDF Image | (LEDs) in Dermatology
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